[stop-imf] The Nation: Letter From Zambia (World Bank/IMF health care horror)

[Robert Weissman]

February 14, 2000
Letter From Zambia
by Mark Lynas

Lusaka

"The problem with taking a blood sample for your malaria test is that the
cockroaches may eat it in the night," announced the nurse. "Ants are an eve=
n
worse problem. The place is infested with them." Siavonga Hospital, on the
shores of Lake Karibe in southern Zambia, is suffering. "We have to put
patients with TB in the same room as women who are giving birth," says one
of the four Cuban doctors who battle to run the place. They also have to
charge fees for their healthcare, and patients have to provide their own
medicines, syringes and clean needles. What if they can't afford to pay? Th=
e
doctor shrugs. "What do you think? They die."

People are dying. Quietly, but in huge numbers, all over Zambia, lives are
being wasted. Wasted not because of some accident of nature but as a direct
result of economic policies imposed by faceless Western planners. For more
than twenty years now the World Bank and the International Monetary Fund
have been forcing "structural adjustment programs," or SAPs, on the bankrup=
t
countries of Africa. Trapped between a near-religious belief in economic
neoliberalism and the US-driven interests of big business, these two
institutions are blind to the havoc they are causing. Almost every country
on the continent has succumbed to their prescription. Across Africa, the
vultures are circling.

The World Bank has claimed that Zambia's reformed healthcare system is a
model for the rest of Africa. "It's true that there are no queues," says
Dickson Jere, a freelance journalist formerly with the Zambia Post, an
independent daily. "But that's because people are simply dying at home."

They're called BIDs--"brought in dead." At the casualty ward in Lusaka's
University Teaching Hospital (UTH), they are increasingly common phenomena,
especially among children. "If you want to see the impact of structural
adjustment on Zambia," Emily Sikazwe, director of the antipoverty group
Women for Change, told me, "Go to UTH."

I went to UTH. It is Lusaka's biggest hospital, where those who can't affor=
d
private healthcare end up. In a packed ward near the main entrance a man
writhed in bed. "I'm dying," he moaned, while his wife stood helplessly by
his side. Emaciated figures shivered under sparse bedclothes. Families
crowded around beds or sat on the floor, bringing food to the sick to
supplement the meager hospital rations of beans and maize meal. In another
ward a preacher harangued a dying woman, whose family stood around with
heads bowed. As he waved his Bible, she struggled to move her lips to
acknowledge him.

Enter the children's ward and the smell hits you like a wall. A musty,
medicinal odor--the smell of sickness and death. Rows of children lie on
small beds, slowly passing away from preventable diseases like TB, malaria
and pneumonia. On the other side of the building is a cleaner, neater ward,
where half the beds stand empty. This is the fee-paying section, where
families who can pay a 100,000-kwacha ($36) deposit can buy a slightly
better chance of life. In World Bank language, this is "user-responsive
healthcare."

Don't just go to UTH. Go also to Misisi or to any of the twenty or so shant=
y
"compounds" that ring Lusaka. In Misisi, barely a kilometer from Lusaka's
town center, Masauso Phiri stands outside the windowless concrete shed that
is his house. Next door an old man nearly died of starvation--luckily, he
was saved by the return of his son from the Copper Belt, where he worked in
the mines. That's not unusual. People are dying of starvation in Misisi. Bu=
t
they do so quietly, wasting away in their houses, too ashamed to venture
out. Things were not always like this.

Phiri, like many of his neighbors, has heard of structural adjustment. It
was because of the SAP that he lost his job as a security guard. It was
because of the SAP that he lost a child--a 3-year-old boy, who died of
pneumonia in 1996. "I know it is meant to put the economy on the right
track, but to me it seems to make us suffer," he says. "We can't eat
policies." He looks at the ground. "I don't have any hope. I don't have any
money, so I can't think of any future. My future is doomed."

Only one in five people in Misisi is employed. The unemployed are part of a=
n
army of jobless, created when economists from the World Bank and IMF decide=
d
that Zambia's public sector was "bloated" and that companies would benefit
from the tonic of privatization and an opening of markets to international
competition. The Zambian government boasts that it has the speediest
privatization program in Africa. But half the companies sold out of the
state sector are now bankrupt. More than 60,000 people have lost their jobs
as a direct result of the economic liberalization program introduced after
1991. With many mouths dependent on one breadwinner, this has thrown an
estimated 420,000 into destitution.

In their desperation, people turn on one another--crime is soaring in the
compounds around Lusaka. I attended the funeral of one old woman, shot in
her house by bandits as she tried to prevent them from entering. In the
darkness outside her house, male friends and relatives sit around the fire
in quiet contemplation. They will spend the night there, in the cold, just
sitting, talking and remembering. Inside the house women wail. The robbers
took nothing. The old woman had nothing to take.

"SAPs cause poverty," says Women for Change's Sikazwe. "And poverty has a
woman's face." Women shoulder the main burden of providing for families, an=
d
girls are the first to be withdrawn from school when a father loses his job=
=2E
Women like Esnart Banda, a widow with five children, who makes about 2,000
kwacha (72 cents) a day selling vegetables in a market near Misisi. Most
days she can afford only one meal for her children, even though the younges=
t
is suffering from TB. Her kids join 40 percent of Zambia's children in
suffering from chronic undernutrition.

It's worth pausing here to look at the figures. In 1980, under the former
socialist government of Kenneth Kaunda, the under 5 mortality rate was 162
deaths per 1,000 births. It's now 202 per 1,000. That means one in five
children in Zambia dies before reaching the age of 5. The average life
expectancy has fallen from 54 in the mid-eighties to 40 now. With the AIDS
epidemic raging, this can only get worse. Over the same period the primary
school enrollment rate has plummeted from 96 percent to 77 percent. Half a
million children are now out of school, out of a total national population
of only 9 million.

These last figures are not accidental. They reflect the results of cuts in
public spending and the introduction of school fees. For example, whereas i=
n
1991 the Zambian government spent about $60 per primary school pupil, it no=
w
spends just $15. Cuts in public spending--the slimming down of a "bloated"
public sector--are a central plank of structural adjustment, as promoted by
the World Bank and the IMF. In one of SAP's greatest ironies, the World Ban=
k
is now recasting itself as a "Knowledge Bank"--even as it condemns millions
of children across Africa to a lifetime of ignorance and illiteracy.

"What if the IMF was to pack its bags and leave Zambia? Do they imagine the
situation would get worse for us?" asks Sikazwe. "What would they say if we
took them to the World Court in The Hague and accused them of genocide?" Ho=
w
does she sum up the impact of structural adjustment on Zambia?
"Devastating."

* * *

Half a world away in Washington, the architects of this human disaster dine
in comfort and seclusion, spending more on one meal than Masauso Phiri's
wife makes in a year of selling buns in their shantytown. Although most
World Bank staff work at its Washington headquarters, those unlucky enough
to be posted in the Third World receive ample compensation for their
misfortune. This includes subsidized housing (complete with free
furnishings), an extended "assignment grant" of $25,000 and a "mobility
premium" to defray the cost of child education. Salaries are tax-free and
averaged $86,000 in 1995, according to a General Accounting Office report t=
o
Congress. No "structural adjustment," then, for this privileged coterie of
bankers and policy analysts. Meanwhile, in Africa a hidden genocide lays
waste the continent.

"It's not right for a bank to run the whole world," says Fred M'membe,
editor of the Zambia Post. "They do not represent anybody other than the
countries that control them. What this means in practice is that the United
States runs our countries." He continues: "Look at any African country
today, and you'll find that the figures are swinging down. Education
standards are going down, health standards going down and infrastructure is
literally breaking up."

In the midst of this chaos, what remains of Africa's wealth is being
plundered. And this, argue many, is the real impetus behind structural
adjustment. "They say if you perform well, there'll be a flow of foreign
direct investment," says M'membe. "Investment" like Shoprite Checkers, the
South African supermarket chain that is colonizing Zambia with the help of =
a
massive government tax rebate. Shoprite has ravaged the economies of entire
towns, undercutting local traders and putting out of business stores run fo=
r
generations by one family.

To make matters worse, Shoprite buys nothing locally. Tax-free produce--eve=
n
maize and potatoes--is trucked in from Zimbabwe and South Africa. Meanwhile=
,
Zambian maize rots in the fields, because the farmers who grow it cannot
find a market. Under the previous government an agricultural marketing boar=
d
was responsible for collecting and distributing produce from the whole
country. Under structural adjustment, the private sector is left to do its
worst. But with the poor state of the country's roads, private traders find
it cheaper to import subsidized maize from the United States. Some farmers
are so desperate that they give their produce away to Lusaka-based dealers,
who promise to return with the earnings. Of course, they never do.

The majority of privatized Zambian businesses have been sold off into
foreign ownership. In the case of Zambia Breweries--producers of the
country's famous Mosi (Victoria Falls) lager--South African Breweries is no=
w
in charge. Zambia Consolidated Copper Mines--which has acted as a
mini-government in the country's Copper Belt region--is now being sold off
to a Canadian and Swiss consortium under pressure from international
lenders, who have refused to give Zambia balance-of-payments support until
the mines are privatized. Many more home-grown companies have simply gone
bankrupt or are struggling to survive.

"Africa can only develop with the participation of its own people," says
Emily Sikazwe. People-centered development is a strategy to which the UN,
NGOs and even the World Bank--which sprinkles its publications with
high-minded concepts--have signed on. Meanwhile, organizing together into a
Campaign Against Poverty, Zambian NGOs are issuing a challenge to the World
Bank and the IMF to allow Africans to participate in deciding how their
countries are run.

If the neoliberal economists of the World Bank are interested in heeding
this call, they will have to leave their plush offices in Washington.
They'll have to go to Lusaka, to Nairobi and to Harare. They'll have to go
to Misisi, to UTH, and they'll have to listen to what people there say.



Mark Lynas is editor of the international human rights and development
website www.oneworld.net. He also coordinates Corporate Watch, an activist
research group based in Oxford, England.




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